Provider Demographics
NPI:1376717314
Name:COPULOS, GEORGIA S
Entity Type:Individual
Prefix:MRS
First Name:GEORGIA
Middle Name:S
Last Name:COPULOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GEORGIA
Other - Middle Name:S
Other - Last Name:KOKKONOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7431 W ATLANTIC AVE STE 53
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-3506
Mailing Address - Country:US
Mailing Address - Phone:561-495-8783
Mailing Address - Fax:561-495-9101
Practice Address - Street 1:7431 W ATLANTIC AVE STE 53
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-3506
Practice Address - Country:US
Practice Address - Phone:561-495-8783
Practice Address - Fax:561-495-9101
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY0000658231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL600007000Medicaid
FL4899935OtherGHI
FLS1265VMedicare PIN